Computers, Internet and Psychotherapy

The demand of psychotherapy often exceeds the availability of therapists. Two studies published in the journal Psychotherapy and Psychosomatics review how modern computer and communication technologies can provide novel opportunities for the provision of stepped care for patients with mental disorders.
In a review and an accompanying editorial by Prof. Isaac Marks and collaborators point out that therapist time is not saved by conducting cognitive behavior therapies (CBT) via e-mail, telephone or video-conference exchanges between patient and therapist in real time. However, time can be saved when treatment tasks are delegated to patient-computer interactions.

Many patients may also prefer to access CBT at home by computer for reasons of greater confidentiality, lessening of stigma and reduction of time needed to travel to a therapist.

This concept was explored by Indra Tumur and colleges in a analysis of 4 studies to compare the effectiveness of a computerized cognitive behavior therapy (CCBT) program, BTSteps, for the treatment for obsessive-compulsive disorder (OCD) against the traditional therapist-led cognitive behaviour therapy (TCBT) and relaxation.

They found that CCBT was as good as TCBT for reducing time spent in rituals and obsessions and and was superior to RLX treatment. Improvement of OCD persisted beyond the end of the CCBT treatment. Therapist guided CBT was more effective than CCBT for all patients overall though not in those who went on to start self-exposure.

In the third study, University of Heidelberg researchers investigated the effectiveness of group therapy delivered through an Internet chat room following inpatient treatment.The main goal of the program was to reduce the risk of losing the therapeutic benefits gained during the inpatient treatment. 114 patients participated in one of two parallel groups of 8-10 patients that met with a group therapist in an Internet chat room.

The groups met weekly for 12-15 weeks for 90 min. Controls were 114 patients who did not participate in the chat groups and were matched by application of propensity score methods.The main criterion was derived from comprehensive assessments of changes in health status comprising the psychological and physical condition of the patients.

Assessments were conducted at admission, discharge and 12 months after discharge. 12 months after discharge, chat participants showed a substantially lower risk (24.7%) for negative outcome than controls (38.5%). Furthermore, a low dropout rate and the high session attendance suggest this novel offer met patients' needs, and thus, opens new avenues for optimizing care for patients with mental disorders.

Baer L, Greist J, Marks IM. Computer-Aided Cognitive Behaviour Therapy Psychother Psychosom 2007;76:193-195 (no abstract)
Tumur I, Kaltenthaler E, Ferriter M, et al. Computerised Cognitive Behaviour Therapy for Obsessive-Compulsive Disorder: A Systematic Review Psychother Psychosom 2007;76:196-202 [Abstract]
Golkaramnay V, Bauer S, Haug S, et al. The Exploration of the Effectiveness of Group Therapy through an Internet Chat as Aftercare: A Controlled Naturalistic Study Psychother Psychosom 2007;76:219-225 [Abstract]

Interface Consultation Services Update

A brief overview of Interface Consultation Services current endeavors:

I. Blog Focus - We continue to post weekly on ICS and Counseling Connections.Our posts include mental health research, news and thoughts we feel providers and clients will find valuable.

II. Counseling Connections - Provides Licensed Professional Online and Telephone Mental Health Counseling, Coaching and Services.

III. PESI Seminars by ICS:

High Risk Callers: Responding to Psychiatric Emergencies Over the Phone. New and exciting sorely needed seminar designed specifically for clinicians, call centers, triage nurses who provide efficient assessment and treatment over the phone. Psychiatric Emergencies over the phone line are DIFFICULT and extremely anxiety provoking. General Medical Clinics are seeing more psychiatric patients. Learn the skills you didn't learn in school to assist these patients.

IV. Telemental Health Triage - We continue our day-to-day service commitment to Riverwood Center to provide professional triage services so their consumers are assured efficient and timely access to mental health services, appropriate level of care assignments and expert telephone crisis triage.

V. MPRI - Michigan Prisoner Re-entry Initiative for the Mentally Ill - ICS are contracted as the Regional Care Coordinators for the Western Michigan providing services to 17 counties. ICS has hired Lee Burdick March 2007 to assist with this initiative. This program continues to grow at a very fast pace and it the only program of it's kind in the US. This speciality program is designed for mentally ill prisoners who are returning to the community. As Care coordinators we provide funding for housing, psychiatric medications, specialized placements as well as care coordination and consultation on some very difficult cases for the program.

VI. Utilization Management Opportunities - We continue to provide acute care preauthorization services for Riverwood Center.

VII. College Level Course - ICS partner, Kathlene LaCour is an part-time facility member at Kalamazoo Valley Community College.

We are seeking other opportunities to expand these kinds of services to other agencies. Please contact us via email by clicking on the link to learn more about how we can service your consulting needs or call (269)929-1292.

"What we are today comes from our thoughts of yesterday and our present thoughts build our life tomorrow. Our life is the creation of our mind." -- Siddhartha Buddha

Death.. One Man's Thoughts....

Checkout this Vlog site by Josh Leo.

He expresses some of his thoughts about death and dying.

Discovering Our True Nature - Online Radio Show

Discovering Our True Nature - Online Radio Show with Host Branden Cohen (click on link to listen to recent shows...

Join Branden for his weekly internet radio show on Tuesday at 1pm or go to link above for live or achived shows. Each begins with a guided meditation and Branden welcomes guests and callers to share their personal experiences and ask questions. The show explores a variety of psychological and spiritual topics.

Branden Cohen is a MA Clinical Psychologist. email him at brandencohen@hughes.net

This week show and guest talk about addiction and ways to heal the most difficult of addictions and the heart.

contact us at... interface_consultation@comcast.net

Today is the Day!

Today is your opportunity to make a real positive difference in your life.

Live this very day with respect and responsibility for yourself and the treasure of today will be with you always.

-Kenn

May Mental Health Month

Welcome to Mental Health Month 2007! The theme for this year's observance is MIND Your Health. For more than fifty years, our country has celebrated May as Mental Health Month to raise awareness about mental illnesses and the importance of mental wellness for all. Mental Health America invites you to join us in this important observance.

Contact Us..

Work related suicide, Mental Illness Increase in Japan

Provided by: Associated PressMay. 17, 2007

TOKYO (AP) - The number of Japanese who killed themselves because of work jumped by 52 per cent last year, while work-induced mental illness also hit a record high, a health official said Thursday.

Compensation paid to the families of workers who committed suicide due to work-related stress was paid out in a record 65 cases in 2006, compared with 42 the previous year, said Health Ministry official Junichiro Kurashige.
The number of workers who received compensation for work-induced mental illness hit 205, up 61 per cent from a year earlier, Kurashige said, citing a recent government report.

Efforts by the government to encourage workers to apply for compensation were partly behind the rise, said Kurashige.

Japan's suicide rate is among the highest in the industrialized world. More than 32,000 Japanese took their own lives in 2004, the bulk of them older Japanese suffering financial woes as the country struggled through a decade of economic stagnation.

The Japanese government has earmarked a substantial budget for programs to help those with depression and other mental illnesses.

See C-Health for more mental health news...

Spirituality, Suicide and Mental Health

Canoe Health Reports....An Canadian conference is drawing attention to the key role spirituality plays in mental health and even for suicidal patients.

Medical schools have started to raise awareness about spirituality, so students entering the health-care field will inquire about their patients' belief systems to better understand their attitudes toward life and death.

To shed more light, the University of Ottawa's department of psychiatry, the Ontario Multifaith Council on Spiritual and Religious Care and Saint Paul University are hosting the third annual international conference on Spirituality and Mental Health today and tomorrow.

Developing a greater understanding of the link between mental health and spirituality is necessary for health-care workers who truly want to help their patients, said Dr. Andre Gagnon, chairman of the conference organizing committee. The same can be said of workers dealing with suicidal patients.

Suicidality has been VIEWED AS AMORAL.
Historically, suicidal thoughts were viewed by religions as amoral and people who suffered from them could be forbidden access to a place of worship and even burial rights, said Gagnon.Over time, religions have grown more accepting of the reality that these people need help.

Researching links between suicide rates and spirituality poses difficulties due to the many other variables associated with suicide.Gagnon said that even the awareness of spirituality in suicide can aid health providers in providing appropriate care."A lot of people at first want to stop the suffering they are in, they don't wish to die as much as to stop feeling so badly," he said.

We are all spiritual beings and to neglect this part of a person in who is experiencing significant distress and psychiatric pain can delay a person's recovery. Treating people as whole beings - mental, physical, spiritual and emotional is key.

Binge Eating/Compulsive Eating Disorder

Psychiatric Times indicates that this disorder is more common than anorexia and bulimia combined, according to a national survey.In DSM- IV this disorder was being reviewed and was indicated to require more research and study to determine if it would be appropriate for admission into the DSM (Diagnostic and Statistical Manual for Mental Disorders).

Most physicians, however, aren't aware of the problem, says James Hudson, MD, director of the Psychiatric Epidemiology Research Program at McLean Hospital and a professor of psychiatry at Harvard."Doctors have a reasonable degree of awareness about anorexia and bulimia, but they're not tuned into binge eating. It's just not as well known," says Hudson, lead author of "The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication". The study, published Feb. 1 in Biological Psychiatry, found that 2.8 percent of the general population has binge-eating disorder -- more than bulimia (1 percent prevalence) and anorexia (0.6 percent) combined.

Treatment for this disorder experts recommend a comprehensive eating disorders program. The programs take a multidisciplinary approach that typically includes nutrition counseling; a behavioral weight control plan with healthy meals spaced throughout the day; medication in some cases; and a strong foundation in cognitive behavioral therapy (CBT) -- considered the gold standard for treating the disorder.

Due to this disorder not being an official diagnosis many insurances will not pay for treatment. Self help programs include reading books with CBT focus and drug treatment with SSRI, appetite suppressants and mood stabilizers. See Psychiatric Times for more information

Who Are You?

A father, mother, wife, husband, sister, brother, boss, employee, devotee, coach, player, student, teacher, etc.

You are not your relations. The core of who you are is not defined by your relationship to friends, family, god or others in general. These are power parts of our being and living in this world.

Is here a you without relationship to others?

So truly, who are you when you look in the mirror and see more than your physical self looking back at you?

Food for Thought....

Yesterday, Today and Tomorrow....

Yesterday is but today's memory, tomorrow is today's dream.

- Kahlil Gibran

Online Counseling Rarely Available

The dearth of mental health services for individuals in need is a debit our nation has felt for at least twenty years, if not indefinitely. A new national survey of commercial health plans has found that most plans provide online information regarding mental health and substance abuse but few provide clinical services such as counseling via the Internet.

Most private health plans offered online provider directories; 81 percent offered educational information; two thirds offered behavioral self-assessment tools, and almost half offered online referral. About one-third offered personalized responses to questions or problems. Only two percent offered online counseling.

“At least in the short term, increasing use of Internet-based tools designed to facilitate and complement, rather than replace, traditional clinical services seems most likely.”

Source: Brandeis University

Telephone-Based Psychotherapy and Depression

Psychiatric Times
By Judith GrochReviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco Mar 22, 2007

SEATTLE, March 22 -- For depressed patients on medication but too sad to seek psychotherapy as well, lasting help may be available by phone researchers found in a follow-up study.

For more than 75% of nearly 400 patients, the positive effects of six months of brief telephone psychotherapy at the start of antidepressant medication endured for 18 months after the first session, including six months beyond the end of all phone therapy, said Evette Ludman, Ph.D., of the Group Health Cooperative Center for Health Studies here, and colleagues.

This study, reported by Dr. Ludman and colleagues in the April issue of the Journal of Consulting and Clinical Psychology, was a follow-up to a 2004 report on the same sample of 393 patients, published in the Journal of the American Medical Association.

The follow-up found that at 18 months, 77% of those given phone-based therapy reported that depression was "much" or "very much" improved, compared with only 63% of those receiving usual care.

In the 18-month analysis, the benefits of telephone psychotherapy in the first six months were sustained during the second six months when only brief booster sessions were provided. Significantly a "robust clinical benefit" endured for six months after all treatment contact was discontinued, the researchers found.

"As with weight control," Dr. Ludman said, "maintaining improvement is the hardest part of treating depression."

Read More...

As you can see using telephone-based therapy can be convenient and effective. If you are in terested in knowing more Contact Us.

How to Choose a Therapist

MayoClinic.Com - Choosing mental health providers can be challenging. Try to match your needs with their experience and specialty. See what issues to consider and which questions to ask.

If you've never consulted mental health providers before, you may not know how to find one who suits your specific needs. Here are some issues and tips to think about, along with questions to ask potential mental health providers.

Consider the types of mental health providers:

You may not realize just how many types of mental health providers are available until you start looking for one. Should you see a family practice doctor? A Psychiatrist? Psychologist? Social worker? Does it even matter?

Several considerations can help guide your decision in choosing among the various types of mental health providers:

The severity of your symptoms
Your medication needs
The provider's level of expertise
Your health insurance coverage

In general, the more severe your symptoms or diagnosis, the more expertise and training to look for in your potential mental health providers. If you may need medications, for instance, you may want to consult a psychiatrist, who by law can prescribe medications and may have more experience with the wide range of psychiatric medications available. On the other hand, if you're dealing with teenage conflicts, you may want to consult a marriage and family therapist. You may even need to see several types of mental health providers to meet various needs.

Contact Us...

Learning....

I've learned that if your heart has never ached you are not alive.

I've learned that a strong man can cry

I've learned that the best things in life really are free

I've learned that there are many risks in life but the biggest is not taking any at all.

Kenn

Women Soldiers' Response to Treatment for PTSD

Psychiatric Times
By Peggy Peck
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine. Feb 28, 2007

WHITE RIVER JUNCTION, Vt., Feb. 28 -- For women soldiers being treated for post-traumatic stress disorder, symptoms improve when the therapy homes in on the original index event, no matter how long ago it occurred, researchers here found.

Compared with therapy that aimed at coping with PTSD symptoms in daily life, women whose therapy focused on the past traumatic events reduced symptoms by more than 70% (effect size, 0.27, P=0.03), investigators reported in the Feb. 28 issue of the Journal of the American Medical Association.

Moreover, the women who underwent "prolonged exposure" therapy were also about two-and-half times more likely to achieve total remission (15.2% versus 6.9%; odds ratio 2.43; 95% confidence interval, 1.10-5.37, P=0.01), said Paula P. Schnurr, Ph.D., of the National Center for PTSD at the VA Medical Center here, and colleagues.

The "maximum benefits of prolonged exposure are observed immediately after treatment and persist over time," she said.

But while the prolonged exposure therapy was more effective, it also had significantly higher dropout rate: 38% versus 21% (P=0.002).

The study randomized 277 women veterans and seven active duty women soldiers to either prolonged exposure or present-centered therapy. The mean age of women was 45 and roughly 31% were married.

The women were enrolled and treated from August 2002 through October 2005 at nine VA medical centers, two VA readjustment counseling centers, and one military hospital.
Both therapies were delivered according to standard protocols in 10 weekly 90-minutes sessions.

"Prolonged exposure included education about common reactions to trauma, breathing retraining; prolonged (repeated) recounting (imaginal exposure) of trauma memories during sessions; homework (listening to a recording of the recounting made during the therapy session and repeated in vivo exposure to safe situations the patient avoids because of trauma-related fear); and discussion of thoughts and feelings related to exposure exercises," they wrote.
By contrast, the present-centered therapy focused "on current life problems as manifestations of PTSD."

Sexual trauma was identified as the "worst" trauma exposure by 68.3% of the women, followed by physical assault (15.8%) and war zone exposure (5.6%). The index trauma usually occurred more than 22 years before the women were enrolled in the study.

The high rate of sexual trauma exposure tracked closely studies of PTSD in civilian women, but Dr. Schnurr pointed that 70% women in this study said their sexual trauma exposure was associated with military service.

The study was limited by the small number of active duty women included-the authors theorized that active duty soldiers might be reluctant to seek treatment because they were "worried about the stigmatizing effects of PTSD, a concern that has been expressed by soldiers serving in Iraq and Afghanistan."

Active duty soldiers, they explained, were likely to be younger than veterans and might have responded differently to the two treatments.

The study was also limited by a higher dropout rate in the prolonged exposure arm, and by the fact that the study was limited to women. But Dr. Schnurr said the findings could "with some caution" be extended to men because published studies suggested that cognitive behavioral therapy was an effective treatment for PTSD in men.

The study was funded by the VA Cooperative Studies Program and the Department of Defense. Dr. Schnurr and reported funding from the Department of Veterans Affairs. Some of her co-authors reported funding from the Department of Defense and three co-authors -- Matthew J. Friedman, M.D., Ph.D., Edna B. Foa, Ph.D., and Patricia A. Resick, Ph.D. -- published books on PTSD treatment for which they received income.

The Secret

On the The Oprah Show last week she had a panel of people talking about "The Secret". This movie, The Secret, and book was created by Australian Rhonda Byrne, and she says that if you follow its philosophy, you can create the life you want—whether that means getting out of debt, finding a more fulfilling job or even falling in love.

Rhonda defines The Secret as the law of attraction, which is the principle that "like attracts like." Rhonda calls it "the most powerful law in the universe," and says it is working all the time. "What we do is we attract into our lives the things we want, and that is based on what we're thinking and feeling," Rhonda says. The principle explains that we create our own circumstances by the choices we make in life. And the choices we make are fueled by our thoughts—which means our thoughts are the most powerful things we have here on earth.

See more about the show at the link above...

The Secret sounds like a new idea but it's a concept we have been using to assist people for a long time. The Secret has gained attention of the people and we would love to discuss it more with you. Contact us..

All Things Being Equal!

After a year of back-and-forth, a group of U.S. senators have reached a compromise on a bill offering "mental health parity" to health plan enrollees who have mental health coverage. While the details are still under discussion, generally speaking the bill would require health insurance plans with a mental health option to cover mental diseases the same way they do physical diseases, including reimbursement, co-payments, deductibles and limits on physician visits. The bill is being championed by Sen. Pete Domenici, who has worked on this issue since 1996, and co-written with Sens. Edward Kennedy (D-MA) and Mike Enzi (R-WY). Creating a workable consensus proposal took years, but everyone involved seems to think the measure can move ahead now. Though health plans argue that such parity would be too costly to sustain, President Bush has previously expressed a willingness so sign a parity bill, so the measure's prospects may be better than many previous versions.

Fierce HealthCare to see more...

NYU Child Study Center
The New York University Child Study Center has identified warning signs of depression in teenagers for parents and tips for helping teens who may be depressed, in light of a new report from the Centers for Disease Control and Prevention (CDC). The CDC study, published in the February 2007 issue of Pediatrics finds that suicide rates in children under 19 years of age increased between 2003 and 2004. Suicide was the only statistically significant increase in child death over this time. Overall, the suicide rate increased by 18.2 percent from 2003 to 2004, an increase largely driven by older teens.

"A teen's statement of a wish to kill him/herself must be taken seriously," said Lori Evans, Ph.D., Director of Psychology Training and the Project Coordinator of TASA (Treatment of Adolescent Suicide Attempters) at the NYU Child Study Center. "Before they actually commit or attempt suicide, teens often make direct statements about their intention to end their lives, or less direct statements about how they might as well be dead or that their friends and family would be better off without them."

"Discussing the problem does not encourage the teenager to go through with the plan," emphasizes Dr. Evans. "On the contrary, it will help him or her know that someone is willing to be a friend. It may save your adolescent's life."

Watch for symptoms of depression lasting longer than two weeks, which may include:
A change in eating and sleeping habits

A marked personality change, exhibiting angry actions or rebellious behavior or withdrawal from friends and regular activities

Involvement in drugs or alcohol or other risky behaviors such as reckless driving

An overreaction to a recent humiliating experience

Difficulty in concentrating and a decline in the quality of school work

Persistent boredom and/or lethargy

Unusual neglect of appearance

Complaints about physical symptoms such as headaches and fatigue

A pattern of giving away or throwing away possessions

Intolerance of praise or rewards

Preoccupation with death in writing songs or poems

An increase in comments such as "I can't take it anymore" or "nobody cares; I wish I was dead"

How to help
Take person's comments regarding self-hate, suicide, or death very seriously

Don't try to convince the person to not feel bad. Don't tell them to "snap out of it" or say "don't feel bad"

Keep in close contact with the person and their parent, teacher, or a good friend

Ask the child or teen what you could do that would be helpful to them

Don't promise to keep any information a secret

If symptoms persist or are dangerous and interfere with daily functioning, consult a mental health professional immediately
See Anxiety Insights for more...